Respiratory System Infections - هات أسئلة PDF

Immune defense of respiratory system Types of microorganisms, morphology and...

Immune defense of respiratory system Types of microorganisms, morphology and Normal flora in the respiratory tract (RT). Objectives  What are 5 ways the microorganisms are prevented from entering into the respiratory system Relation of (What keeps Lower Respiratory tract sterile?) Bacterial infections periodontal disease and respiratory disease of the Diseases, pathogenesis, Respiratory System The basic knowledge manifestations, about the most common bacterial pathogens of with highlight on 1. Hair in nasal passages Upper and Lower diagnosis, respiratory tract including: treatment and prevention. 2. IgA antibodies 3. Normal microbiota (microflora) of oropharynx Bacterial RT infection in immunocompromised mm4. Ciliary escalator patients (opportunistic) E.g., Pseudomonas aeruginosa as a nosocomial pathogen and its contribution in the pathogenesis of cystic fibrosis 5. Alveolar macrophages upperflora alveoli sterile lower Normal Respiratory Tract Flora Respiratory Transmission of infections periodontal disease & Respiratory disease periodontal disease & Respiratory disease  Generally, bacterial respiratory infections occur due to the Mainly in the UPER Respiratory tract inhalation of fine droplets from the mouth into the lungs. Lower respiratory system (alveoli) is normally sterile  Identical facultative and anaerobic  The bacteria found in plaque begin to colonize in gingival strains, including P. aeruginosa and S.aureus, Airborne tissue, causing an inflammatory response in which the body What keeps LRS sterile? Tuberculosis destroys both gum and bone tissue. are found in periodontal pockets and sputum samples,  Bacterial spread – The specific type of oral bacterium that causes periodontal disease can easily be drawn into the lower suggesting that: respiratory tract. Once the bacteria colonize in the lungs, it can cause pneumonia periodontal pockets is a potential and exacerbate serious conditions such as chronic obstructive Droplet source for the respiratory infection’s pulmonary disease (COPD) e.g. strep. Throat patients Meningiococcal dis.  Many different respiratory diseases are linked to periodontal disease such as:  Pneumonia, COPD, and bronchitis are among the most common. Is Can include pathogens (carrier state) Smoking in periodontal and respiratory infections COPD chronic obstructive pulmonary disease periodontal disease & Respiratory disease  Smoking is thought to be the leading cause of  periodontal disease can worsen conditions such as (COPD) and play a causal COPD and other chronic respiratory conditions. role in the contraction of pneumonia, bronchitis and emphysema. COPD is a chronic inflammatory lung  Tobacco use also damages the gingiva and compromises the health of the oral cavity & flora. Upper Respiratory disease that causes obstructed airflow from  Tobacco use, causes gum pockets to grow deeper the lungs. Common in smokers and also accelerates attachment loss. Tract both periodontal pathogens bacteria, and lung pathogens (Acinetobacter baumannii, K. pneumoniae, P. aeruginosa and S. infections pneumoniae) are present in subgingival plaque biofilm and tracheal aspirate of patients with severe acute exacerbations of COPD (Tan et al., 2014), indicating that : – oral microbiome is a reservoir of (URTI) respiratory pathogens – periodontal pathogens may contribute to the pathology of COPD. a 6 is aige.mg was  v01 W now 44 w̅ Microbial Infections of the Upper Respiratory Tract URTI Otitis Media  Infection of the middle ear (can be acute/chronic)  Certain areas of the upper respiratory system can become infected  URTI are common complaint in health care Otitis Media  Caused by viruses OR bacteria  2nd most common diagnosis in children? (Anatomy of eustachian tube in children.. small opening easily blocked)  Viruses are the cause of MAJORITY of Upper Respiratory Infections And are mostly mild-modrate and self-limiting…? (URTI)  Risk factors: spread from throat / sinus infections  How via eustachian tube leading to its obstruction, fluid trapped behind ear drum, leading to middle ear infection,  Pus accumulation & pressure on the tympanic membrane which become erythematous , dull, bulge and may rupture & drainage  Bacteria causes some URT infections, which may be:  Flora present in the throat / sinuses  primary bacterial infection  secondary bacterial infection which means:(superinfection  bacterial throat infection can spread via eustachian tube (in  Symptoms: fever, ear pain (pulling), hearing problems to existing viral infection) Children narrow horizontal) easily blocked by any  Diagnosis: clinically (otoscope). look for other URTI  If necessary: tympanocentesis relives pressure and obtain specimen inflammation, causing bacterial overgrowth  In ruptured membrane: exudate sample: gram stain and culture  (even in viral sinusitis) the block cause 2ndry bacterial infection URTI Otitis Media Complications URTI Otitis Media Complication of otitis media if untreated or improperly treated: URTI Sinusitis spread of bacterial infection beyond the mucosa via Mastoidal air cells (URTI)  Inflammation of paranasal sinuses (commonly maxillary)  Local e.g. (mastoiditis) , (facial nerve palsy)  Viral causes: Mild cases -- if no red flags -- watchful waiting for improvement on analgesics first 48 hr. only  Cranial: meningitis (CNS infection) / brain abscess  Start as Viral infection which obstruct sinus orifice, leading to mucous  If NOT improved … suspect bacterial infection and treat as follows!! accumulation…leading to: secondary bacterial infection  Bacterial common organisms include  Streptococcus pneumoniae (most common) Treatment Failure  Hemophilus influenzae (20-30%)  Chronic / recurrent otitis media  Diagnosis: clinically: Fever, purulent nasal discharge headache and  Moraxella catarrhalis (10-15%)  Streptococcus pyogenes (8-10%)  Hearing problems facial(sinus) pain.  Require Antibiotic Treatment: as per specimen culture if available  Empirically: amoxicillin + clavulanate = (Co Amoxi-Clav) Ventilation/drainage tubes:  Mild cases – watchful waiting for improvement on analgesics 48 hours if patient allergic to penicillin: cefuroxime, cefpodoxime inserted to release pressure and  Moderate/Severe OR mild not improved … suspect bacterial superinfection (2nd or 3rd Cephalosporine) prevent recurrent infections  Common bacteria are Streptococcus pneumoniae, Hemophilus influenzae and Moraxella catarrhalis  amoxicillin (in resistance +clavulanate) = Prevention: Pneumococcal vaccine (mainly prevent invasive pneumococcal disease) if patient allergic to penicillin: cefpodoxime (3rd Cephalosporine) or azithromycin (Macrolide) Complication if untreated or improperly Prevention of sinusitis complications Odontogenic sinusitis Odontogenic sinusitis treated: Sever cases / accumulation of fluids/ obstruction can lead to otitis Pathogenesis :  sinusitis from dental or dentoalveolar complicated infection or  attachment of bacteria to the outer surface of teeth, eventually breaking down the outer enamel and inner dentin and media making its way into the vital pulp. Once the infection enters the pulp, it leads to the necrosis and pus formation. The body surgery that damage the floor of (commonly) the maxillary sinus: hatinviral Important to prevent that in viral sinusitis by nasal irrigation and anti prevent sinus is unable to eliminate the source of infection because the necrotic pulp is protected within the tooth roots. Bacteria  the Schneiderian membrane that protects sinuses colonize the apical portion of the root and their toxins can damage tissues causing a periapical infection. An acute, histamines  Etiology: rapidly-spreading infection is much more destructive than slowly-developing inflammation, affecting the adjacent maxillary mi dentoalveolar surgery or odontogenic infection with perforation of the Schneiderian sinus in a short time. Bacteria from the lesion can spread to the adjacent tissues and activate a reaction from the Schneiderian membrane epithelium which seems to be hypertrophic and inflamed. membrane. polymicrobial (bacteria from both oral cavity and upper respiratory system  Symptoms similar to sinusitis: mainly facial pain or pressure, nasal congestion, purulent rhinorrhea that may be unilateral, cacosmia, Frequent sinus infections?? are involved, with anaerobic majority) and postnasal drip , +/-dental pain Check for odontogenic sinusitis!! por  Diagnosis dental and medical examination, and past medical/dental history. buccal mucosa and vestibule for swelling or erythema. The pulp is tested by using electric or thermal pulp vitality testing, percussion, and palpation in order to determine if the tooth is healthy. Radiology is important  Treatment targeting aerobe and anaerobe bacteria. For this reason, amoxicillin combined with clavulanate, which is a beta lactamase inhibitor, is preferred.  (URTI) pharyngitis (throat infections) Strep throat pharyngitis Pharyngitis & Tonsillitis inflammation of throat and painful swallowing (URTI)  VIRUSES are Most Common cause of pharyngitis, may be accompanied with (URTI: rhinorrhea sinus/ear pain, cough and low fever) ----------------------------------------------------------------------------------------  Bacterial pharyngitis NOT common (10%) In bacterial  Centor Criteria suggesting Bacterial infection: (Streptococcus pyogenes) pharyngitis:  High fever >38.5°C (usually with loss of appetite) High neutrophils  tonsillar enlargement and/or exudates, count  tender cervical lymphadenopathy  absence of a cough Most important bacterial cause: Streptococcus pyogenes because of immune complications after infection e.g rheumatic fever other bacterial causes: Mycoplasma pneumonia Chlamydia pneumonia Non-immunized children: Corynebacterium diphtheria URTI Epiglottitis LOWER Respiratory tract infections (LRTI) LRTI Pneumonia  Inflammation of the Epiglottis LOWER  Pneumonia is inflammation of lung (alveoli)  Types of Pneumonia:  It is bacterial infection caused mainly by Haemophilus influenzae (B) it is now rare (Vaccination) Respiratory where/How acquired? Symptoms: rapid sore throat, dysphagia, airway obstruction (Emergency) Tract infections Community-acquired pneumonia is when someone develops pneumonia in the community (not in a Diagnosis by laryngoscopy: (swollen red epiglottis) hospital).  Bronchitis Treatment : (Emergency) Intravenous ceftriaxone & corticosteroids I Prevention : childhood vaccine (LRTI)  Bronchiolitis Healthcare-associated pneumonia is when someone develops pneumonia during or following a stay in a healthcare facility e.g., Hospitals  Pneumonia Ventilator-associated pneumonia is when someone gets pneumonia after being on a ventilator, a machine that supports breathing. inw.is p Autoinoculation in persons carrying high counts of bacteria in their upper respiratory tract e.g. poor oral hygiene, oral infections, plaque  LRTI Pneumonia (community acquired) Pneumonia is inflammation of lung (alveoli) Symptoms of Typical pneumonia:  cough producing sputum  oral microecosystem is a  Fever,  Rusty (brown red) sputum--- strept.  Transmission:  chest pain, Pneumonia main source of lung  from community via URT inhalation of virulent or large dose of  shortness of breath  Currant jelly sputum--- Klebsiella Pneumonia organisms (or aspirated from oropharynx) microbiome and associated  Transmission through Direct person-to-person contact via respiratory with respiratory diseases like droplets pneumonia, chronic  Autoinoculation in persons carrying high counts of bacteria in their obstructive pulmonary upper respiratory tract in poor oral hygiene, oral infections, plaque disease, lung cancer, cystic  Predisposing factors:  high rates of oral streptococci and anaerobes were fibrosis lung disease and found in the specimens of pneumonia patients asthma (Yamasaki et al., 2013).  The level of periodontal disease has a significant association with the mortality of pneumonia  the anaerobic bacteria from the dental plaques of  poor oral health (especially patients with periodontal disease periodontal disease) are related with risk of multiple ii  Bacterial organisms of pneumonia Typical pneumonia Chest x-ray (community acquired)  Common Bacterial pneumonia: Pneumococcal Pneumonia  Streptococcus pneumoniae  Streptococcus pneumoniae most common  Most common cause 80% of bacterial pneumoniae  One lobe affected Typical pneumoniae  Gram positive diplococci (Encapsulated) culture  Hemophilus influenza common organism  Virulence factors: capsular polysaccharide protection from immunity classical signs/symptoms.  Klebsiella pneumoniae treated by antibiotics of common IgA protease to colonize mucosa of URT bacterial infections.  Transmission Aerosol inhalation from patient or asymptomatic carrier  MRSA methicillin resistant staph aureus Autoinoculation in persons carrying the bacteria in their upper respiratory tract e.g., (otitis media)  Symptoms (Typical pneumonia) cough with sputum, fever, shortness of √√ XX  Mycoplasma pneumoniae Atypical pneumoniae breath, pleuritic chest pain Uncommon organism Sputum has many neutrophils and few epithelial cells  Diagnosis: chest x-ray  Legionella pneumophila Milder symptoms. mycoplasma haven’t cell wall therefore, beta-  Sputum: Rusty (brown red) sputum (NOT saliva)  Chlamydophila pneumoniae lactam antibiotics which act on cell wall are not recommended Gram stain= gram positive cocci Antibiotics: macrolide family or quinolones Culture: on blood agar= alpha hemolysis colonies Tuberculosis (Mycobacterium tuberculosis) sputum can be induced (by nebulized hypertonic saline) Immunocompromised e.g., cystic fibrosis: pseudomonas aeruginosa  If hospitalized, Blood specimen culture (positive=bacteremia in 15-25%) Gram stain shows gram positive cocci stas g ff Typical pneumonia Other Bacterial LRTI Haemophilus influenzae Pneumococcal Pneumonia  Treatment of Streptococcus pneumoniae :  Lung Abscess  Lung empyema Required by student to search and study from Gram stain: Negative, bacilli (capsulated or non-capsulated) outpatient: (Mild cases, empiric therapy) 6 Antigenic structures (types) of capsulated strains: a, b, c, d, e, f  necrosis of the lung tissue and formation of  Collection of pus exudate with textbook or reliable source about : Most pneumococci are sensitive to penicillin: (Macrolide) +/- (amoxicillin clavulanate) cavities (more than 2 cm) containing important serological type is type b. (H. influenza type B = Hib) ** if patient allergic to penicillin: azithromycin (Macrolide) /or/ Levofloxacin necrotic fluid caused by microbial infection neutrophils in the pleural space Microbiological Features of bacteria involved in Respiratory The Hib vaccine in childhood is protective from invasive disease and therefore it is now a 15-35% pneumococci are penicillin resistant: treated by Vancomycin or Levofloxacin Tract Infections it  Cause: aspiration pneumonia, rare infection (Quinolones Not used for children)  caused by aspiration, which may occur during altered e.g., consciousness and it usually causes a pus-filled cavity trauma Moderate/sever case need Hospital admission: broad spectrum Intravenous antibiotics Klebsiella pneumoniae (gram negative bacilli)  Diagnosis: pleural fluid culture/blood culture  Causes: Transmitted by inhalation of droplets into respiratory tract, causing colonization or upper or e.g., ceftriaxone(3rd generation cephalosporin) + (macrolide or quinolone) CT scan lower respiratory infection: pneumonia until narrowing of spectrum based on culture and antibiotic sensetivity result  Broad spectrum antibiotic to cover mixed flora is the Strep. Pneumonia Mycoplasma pneumoniae mainstay of treatment. The Hib infection spread from nasopharyngitis and enter bloodstream and can cause Klebsiella Pneumonia(hospitalized) Chlamydophila pneumoniae meningitis / septicaemia in NON-VACCINATED infants and pre-school age Complications: Pneumococcal pneumonia kills about 1 in 20 infected patient Diagnosis: pus aspiration culture Treatment:  blood infection (bacteremia,… septicemia) 25% of H. influenza type B produce beta-lactamase enzyme which destroy penicillinase  CNS infection: Meningitis (fever, neck stiffness, headache) CT scan sensitive beta-lactam antibiotics e.g., ampicillin.  Empyema (infection around the lungs and in the chest cavity) Treatment: surgical drainage of pus Therefore, clavulanic acid is added to Amoxicillin to protect amoxicillin from beta lactamase  Pericarditis (inflammation of the outer lining of the heart)  Endobronchial obstruction (blockage of the airway that allows air into the lungs), with atelectasis (collapse within the lungs) combined with antibiotics destruction and abscess (collection of pus) in the lungs I.V. Ceftriaxone is stable for beta lactamase Prevention: Pneumococcal vaccine: prevent invasive disease, bacteremia/meningitis a Bacterial respiratory Opportunistic infections? Despite even intensified antibiotic therapy, no TIE eradication of chronic P. aeruginosa infections Opportunistic infections in The major immunocompromised host groups are those with: Opportunistic infections occur when loss of immunocompromised person HIV/AIDS. innate or adaptive immune responses, allows infection by (weak-virulent) organisms 1T Solid organ and hematopoietic cell transplants. that do NOT normally cause infection Malignancy / chemotherapy or radiation therapy. most people who experience chronic respiratory problems suffer from low immunity. Primary and acquired immunodeficiencies and This low immunity allows oral bacteria to embed itself above and below the gum line without being challenged by the body’s immune system. why autoimmune diseases. This accelerate the progression of periodontal disease, it also increase risk of Other predisposing Diseases such as Cystic fibrosis developing emphysema, pneumonia and COPD(chronic obstructive pulmonary disease) and Diabetes Millitus Example: Long term bedridden hospitalized patients o pseudomonas aeruginosa Opportunistic Infection of Lower Respiratory Tract  Pseudomonas aeruginosa bacteria Nosocomial infections?? Mycobacterium Tuberculosis TB Obligate Aerobic acid-fast bacilli (not gram stained) Gram-negative bacilli Nosocomial infections acid fast=resist acid decolorization because of 60% lipid & Aerobic with polar flagella Commonly found in the environment = (Health Care / hospital Infections) are infections that acquired in hospitals and other healthcare facilities. Mycobacterium Tuberculosis TB waxy cell wall  difficult to treat, multiple antibiotics Slow growing  long time to treat (minimum 6 Month) – Soil and Water and at any moist location Ventilator-associated pneumonia Tuberculosis generally affects the lungs, but can also affect other – Also found in 10% people as normal flora of the colon. Healthcare-associated pneumonia parts of the body. Pseudomonas produces two pigments. Caused by gram positive and gram-negative bacteria, such as Pseudomonas aeruginosa, K. Most infections do not have symptoms !! pneumoniae, enterococci and Enterobacter spp. a. Pyocanin. It gives a blue color to the pus in wounds. The increasing of dental plaque is also related to the incidence of nosocomial Pulmonary TB: b infections of the patients in the intensive care units (ICUs) b. Pyoverdin( Flourescein). A yellow green pigment which fluoresces Air born Transmitted by respiratory aerosols that arise from under ultraviolet light. patients with open pulmonary tuberculosis in: (coughing / sneezing) Exotoxin A, which causes tissue necrosis. Dental hygiene kit is recommended in ICU l Productive cough is the most common symptom l +/- wight loss, night sweat l Abnormalities on the chest radiograph. Treatment of P. aeruginosa infections:.Resistant / multidrug resistant organisms e.g., P.aeruginosa, MRSA, Often a two-drug combination is employed Acinetobacter l Screening test: Tuberculin skin test (type IV hypersensitivity) And Resistant strains can emerge Higher Mortality , immediate IV broader spectrum antibiotics!! l Diagnosis: sputum culture 7 Mycobacterium Tuberculosis pathogenesis Referral of patients with suspected / confirmed TB disease to a facility with Person with Latent TB Infection propionate.gg TB Disease Person with appropriate environmental controls and respiratory- protection controls for urgent y.igg dental procedures Has a small amount of TB germs in Has a large amount of active TB e.g. negative pressure room his/her body that are alive but inactive germs in his/her body N95 respirators well fitted Cannot spread TB germs to others May spread TB germs to others Does not feel sick, but may become sick May feel sick and may have symptoms if the germs become active in his/her such as a cough, fever, and/or weight body loss Usually has a positive TB skin test or TB Usually has a positive TB skin test or TB blood test result indicating TB infection blood test result indicating TB infection Should consider treatment for latent TB Needs treatment for TB disease infection to prevent TB disease 54 Complications of Antibacterial Chemotherapy (Antibiotics) Prophet peace be upon him advised 1400 Years ago 1- Development of drug resistance e.g., 15-35 % of streptococcus pneumonia resistant to penicillin/amoxicillin 2- Super infection 3- Hypersensitivity 4- Toxicity